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Interview with Martin McKneally

Martin McKneally
Martin McKneally

1. What attracted you to come to Toronto?

Four decades ago, when I was practicing in Albany, NY, I began a stimulating collaboration with the Toronto thoracic surgical group in clinical trials of the Lung Cancer Study Group. Griff Pearson and Bob Ginsburg were world leaders in academic thoracic surgery. I became a student of the Toronto school of thoracic surgery by correspondence and frequent visits. When I was invited to join the Toronto faculty in 1990, I was delighted to accept.

2. What sparked your interest in pursuing surgical ethics?

During the 1960’s, I was appointed as a general surgery resident at the University of Minnesota to serve on the transplant committee. We were charged with advising on decisions about dialysis, kidney donor selection, and other ethical issues related to those completely new technologies. Ethical issues in surgery continued to interest me during my career. When I retired from clinical surgery, surgical ethics was a logical next chapter to explore, and the Joint Centre for Bioethics had just appointed Peter Singer as its dynamic young founding director.

3. You have published many papers – is there a particular article of which you are most proud?

The Entrustment paper (McKneally MF, Martin DK. An entrustment model of consent for surgical treatment of life-threatening illness: Perspective of patients requiring esophagectomy. JTCVS 2000; 120:264-269). That study taught me the value of qualitative research and confirmed the importance of asking for the patients’ perspective. Their common-sense view of informed consent was quite different from the one I was learning and teaching as a novice in bioethics. The opening quotes tell the story: “The surgeon said, ‘So, it’s your decision.’ I said, ‘I’m going to leave it in your hands.’ -Esophagectomy patient.”

4. You have trained many surgeons – when looking at your disciples in Thoracic Surgery, who has surprised you most with their career achievements?

I am not surprised, but dazzled by the accomplishments of Shaf Keshavjee who has risen to a world leadership position in the scientific development of lung transplantation, while managing an outstanding surgery department, research lab and building a clinical practice focused on the most complex thoracic problems.

5. Since 2003 you have interviewed many for the Spotlight – which stands out most in your memory?

I followed the interview suggestions of my chairs and others in the department who volunteered ideas. There were so many stars, it’s hard to choose. One of the most instructive was interviewing the first orthopedic residents to enter the Competency Based Curriculum. I learned the positives and the negatives by hearing the first-hand experience of Jeremy LaRouche and Sebastian Tomescu (see Surgical Spotlight article 2010). Their enthusiasm and lessons from the early phase of the learning curve have helped the program flourish to its present level, described in this issue by Markku Nousianen’s recent update (see page 11). A recent fun experience was reporting David Naylor’s Kergin Lecture (see page 20). I had the opportunity to learn from his skilled editing of my draft. He declined my offer to add his name to the byline, so I left mine off as well.

6. After your distinguished career in Academic Surgery, do you have any advice for surgeons at the start of their careers?

Find a problem that stirs your enthusiasm and creative imagination. Attract and work with colleagues who are better than you are. Share credit, income, responsibility, and all the rewards of academic surgery - the highs and the lows. Put family and friendship first, and the rest will follow.

7. What are your academic goals in Boston?

I’d like to establish a formal program that will help surgeons become scholars in Surgical Ethics.

Mark Camp, Assistant Professor,
Division of Orthopaedic Surgery,
University of Toronto

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